When patients in a mental health crisis end up stuck in Minnesota emergency rooms, they stay an average of 25 hours longer than necessary, taking up not only hospital space but also the time of doctors and nurses who could be focusing on the next emergency.
The researchers recorded the length of these delays. Studying patient activity A study conducted over a 14-day period at more than 30 Minnesota hospitals last fall also provided important evidence about which patients are most likely to experience delays and why.
Knowing which patients are at risk can help states develop targeted treatments for those populations and prevent mental health crises and hospital visits, said Kristin Dillon, co-author of the Wilder Research study, which released the report Monday with the Minnesota Department of Health.
“Hospital delays in discharging patients when they are able to be discharged are harmful to patients, caregivers, hospital staff and the health care system,” she said. “However, without understanding the underlying reasons behind discharge delays, we cannot take steps to effectively address them.”
Monday’s findings: Advisory Board It was created last year to help alleviate the worsening problems of delayed care and emergency room and hospital congestion in Minnesota.
Since the COVID-19 pandemic began, nursing homes and rehabilitation centers have become increasingly understaffed and short on beds, leaving hospitals stuck with frail, elderly patients in their beds. Emergency rooms in the Twin Cities have treated patients on gurneys in hallways during peak bed shortages. But in many ways, these delays have exacerbated a long-standing problem of patients having mental health crises getting stuck in emergency rooms with nowhere to go.
During the study period, the hospital’s inpatient psychiatric unit was nearly full and could not accept new patients from the emergency department until space could be found to discharge existing patients to residential or outpatient treatment programs. The study looked at 182 patients from the hospital’s psychiatric unit who had delayed discharges and, on average, took eight days longer than necessary to be discharged.
But the problem was more complicated than patients waiting for spaces in treatment programs: One in five patients confined to inpatient units had their treatment delayed by court decisions about civil detention or decisions about eligibility for insurance benefits or waiver programs, the study found.
Only 6 in 10 patients who were trapped in the ED required inpatient treatment. The rest were trapped for other reasons, such as arranging transportation home or being delayed for an outpatient treatment appointment. One-third of trapped patients were sent home directly from the ED.
M Health Fairview is addressing the issue, opening what it calls an EmPATH unit at its Edina hospital to provide a relaxed environment and transitional care for patients who can be transferred from the emergency department. The health system also is partnering with for-profit Acadia Healthcare to reopen its Bethesda Hospital campus in St. Paul as a psychiatric facility next year.
In some ways, the delays reported in the report underestimated the problem. They were calculated only for patients who were discharged during the two-week study period. About 5% of ER patients hadn’t been discharged by the end of the study, and some remained in treatment for the entire two weeks. Some hospitals had endured extreme cases, such as Ridgeview Medical Center in Waconia, which kept a child with behavioral problems hospitalized for months.
State lawmakers were so concerned about the 2022 delay that they exempted health care facilities wanting to add psychiatric capacity from Minnesota’s moratorium on hospital construction through 2027. But research makes clear that community and preventive treatment programs that keep people out of crisis situations are most needed, said Dr. Will Nicholson, vice president of medical affairs at East Metro Hospital in Fairview.
“If we can prevent disease, we can address it upstream and take better care of people,” he said.
For two decades, Minnesota has been mired in a chicken-and-egg debate over whether to use its limited budget to build more inpatient beds or to reduce the need for inpatient beds through prevention programs. In 2008, state health economists blocked a proposal to build a psychiatric hospital in Woodbury by what was then called Prairie St. John’s, arguing primarily that prevention programs were needed. The hospital later renamed PrairieCare and built and expanded a children’s psychiatric hospital in Brooklyn Park.
Adding more beds in an era of workforce shortages isn’t the only solution, says Sue Abderholden, director of the Minnesota chapter of the National Alliance on Mental Illness. Minnesota previously addressed the psychiatric treatment shortage by creating stepped-care services called intensive inpatient services to ease the strain on hospitals. There are about 60 intensive inpatient services in the state, but many of them struggle to find enough staff and are operating well below their 16-bed capacity, Abderholden says.
Abderholden said the Legislature approved funding this year for counselors who can see patients who show signs of difficulty, such as skipping medication or doctor’s appointments. “We’re trying to address it long before it becomes a crisis, before they need an emergency department or a crisis team,” Abderholden said.
